Knee Replacement Surgery

Knee replacement surgery is elective surgery. Any surgery is considered elective if it is for a condition that is not life threatening. Knee pain may not kill you but severe chronic pain is difficult to live with.

In advanced cases of knee osteoarthritis the joint-cushioning cartilage may be completely destroyed and there may be severe chronic pain. However, the severity of damage does not always correlate with the symptoms.

There are non-surgical treatments for controlling the symptoms of knee osteoarthritis. Before contemplating knee replacement surgery, the following treatments should be given a fair trial:

Exercise: Exercise strengthens the muscles around the knee so they can absorb shock before it reaches the knee joint.

Weight Loss: When walking the force on the joints is up to five times the body weight. Even losing ten pounds can make a difference.

NSAIDs: NSAIDs reduce both pain and inflammation. Long-term use may cause ulceration of stomach lining and is not always a viable option. The COX-2 inhibitors are a type of NSAID that are less likely to cause stomach ulcers with long-term use than the other NSAIDs, however, there are potential cardiovascular risks involved with Cox-2 Inhibitors. There may be an increased risk of serious cardiovascular events with all of the NSAID's (with the exception of Aspirin), which is dose-related.

Glucosamine / Chondroitin Supplements: Both glucosamine and chondroitin occur naturally in the body. They may be as effective as NSAIDs without the gastrointestinal side effects.

SAMe supplements may relieve the pain of osteoarthritis in some people but is very pricey and many people cannot afford this supplement .

What is Knee Replacement Surgery (also called total knee arthroplasty)

During knee replacement surgery damaged bone and cartilage are shaved from the bones of the knee joint (thighbone, shinbone, and kneecap) and replaced with metal and plastic components.

The main parts of an artificial knee joint include metal caps for the thighbone and shinbone and a high-density plastic cushion that replaces lost cartilage.

Partial knee replacements can be done if the damage is limited to one area of the knee. Fewer compartments are replaced than in total knee replacements, which helps preserve bone (implants may wear away bone around them) and the knee feels more 'normal.'

Knee replacement surgery is gaining popularity, not only for seniors but also for middle-aged people.

Knee replacements do not last forever. For this reason, many physicians recommend putting a knee replacement off as long as possible. If a middle-aged person gets one, they will eventually need another replacement to replace the worn-out implant. Knee replacement implants usually last as least 10 years with some lasting 20 or more years. Younger people tend to be more active than the elderly, so a knee implant may wear out more quickly in younger patients. Implants sometimes wear away bone, making it more difficult to anchor the next replacement knee implant.

OXINIUM" Oxide (from Smith & Nephew Inc.) is a longer lasting material introduced in 1997 being used in some knee implants. VERILAST" (2006) combines OXINIUM" alloy and highly cross-linked polyethylene. This technology is used in the Legion Primary Knee System, which received FDA 510 marketing clearance in April 2010 for long-term wear claims. It is expected to last 30 years.

There are other factors involved in the success of a knee replacement besides the materials of the implant - the skill and experience of the surgeon may play the most important role. The implant must be properly aligned to avoid early wear and loosening of the implant. The patient, while encouraged to exercise, must avoid high-impact activities such as jogging, running and jumping to avoid loosening of the implant. Being overweight can also accelerate wear of the implant.

RISKS: There are risks involve in any surgery. Blood clots are more likely to form after knee replacement surgery than other surgeries. Precautions are taken to reduce the risk of blood clots forming.

The rate of postoperative complications is also lower when the knee replacement is performed by a surgeon who has performed high volume of surgeries as well as performed in a hospital that perform a high volume of procedures.

Knee replacement surgery is usually a last resort  considered only after all other methods of pain relief have not provided adequate pain management.

NIH (National Institutes of Health) Consensus Development Conference on Total Knee Replacement

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